scholarly journals Idiopathic neonatal hemoperitoneum presented as scrotal hematoma: it’s a diagnostic challenge?

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Salatto Alessia ◽  
Indrio Flavia ◽  
Campanella Vittoria ◽  
Maggipinto Cosetta ◽  
Cocomazzi Raffaella ◽  
...  
Keyword(s):  
Rapid Onset ◽  
Careful Consideration ◽  
Unknown Etiology ◽  
Diagnostic Challenge ◽  
Case Presentation ◽  
Scrotal Ultrasound ◽  
Scrotal Hematoma ◽  
Diagnostic Approaches ◽  
Diagnostic Work ◽  
Work Up

Abstract Background Idiopathic hemoperitoneum in the newborn is an entity very rarely encountered in clinical practice. Case presentation A case of scrotal hemorrhage (SH) associated with intrabdominal hemorrhaging and acute anemia is presented. Indications for early surgery included a massive scrotal hematoma, rapid onset of severe anemia, and unknown etiology. Conclusion Clinical and diagnostic approaches in a case of neonatal scrotal hematoma should be given careful consideration as abdominal in origin, and a pre-operative computed tomography (CT) scan or magnetic resonance image (MRI) in addition to an abdominal/scrotal ultrasound should be added as part of the diagnostic work-up.

scholarly journals Parasitic hypereosinophilia in childhood: a diagnostic challenge

2018 ◽  
Vol 10 (1) ◽  
pp. 2018034
Author(s):  
Roberto Antonucci ◽  
Nadia Vacca ◽  
Giulia Boz ◽  
Cristian Locci ◽  
Rosanna Mannazzu ◽  
...  
Keyword(s):  
Eosinophil Count ◽  
Hypereosinophilic Syndrome ◽  
Igg Antibodies ◽  
Diagnostic Challenge ◽  
Etiological Diagnosis ◽  
Maximum Value ◽  
History Of ◽  
Diagnostic Work ◽  
Patient’S History ◽  
Work Up

Severe hypereosinophilia (HE) in children is rare, and its etiological diagnosis is challenging. We describe a case of a 30-month-old boy, living in a rural area, who was admitted to our Clinic with a 7-day history of fever and severe hypereosinophilia. A comprehensive diagnostic work-up could not identify the cause of this condition. On day 6, the rapidly increasing eosinophil count (maximum value of 56,000/mm3), the risk of developing hypereosinophilic syndrome, and the patient’s history prompted us to undertake an empiric treatment with albendazole.The eosinophil count progressively decreased following treatment. On day 13, clinical condition and hematological data were satisfactory, therefore the treatment was discontinued and the patient was discharged. Three months later, anti-nematode IgG antibodies were detected in patient serum, thus establishing the etiological diagnosis. In conclusion, an empiric anthelmintic treatment seems to be justified when parasitic hypereosinophilia is strongly suspected, and other causes have been excluded.

scholarly journals Causes of brain dysfunction in acute coma: a cohort study of 1027 patients in the emergency department

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Wolf Ulrich Schmidt ◽  
Christoph J. Ploner ◽  
Maximilian Lutz ◽  
Martin Möckel ◽  
Tobias Lindner ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Laboratory ◽  
Brain Dysfunction ◽  
University Hospital ◽  
Unknown Etiology ◽  
Efficient Management ◽  
Observational Study Design ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Abstract Background Coma of unknown etiology (CUE) is a major challenge in emergency medicine. CUE is caused by a wide variety of pathologies that require immediate and targeted treatment. However, there is little empirical data guiding rational and efficient management of CUE. We present a detailed investigation on the causes of CUE in patients presenting to the ED of a university hospital. Methods One thousand twenty-seven consecutive ED patients with CUE were enrolled. Applying a retrospective observational study design, we analyzed all clinical, laboratory and imaging findings resulting from a standardized emergency work-up of each patient. Following a predefined protocol, we identified main and accessory coma-explaining pathologies and related these with (i.a.) GCS and in-hospital mortality. Results On admission, 854 of the 1027 patients presented with persistent CUE. Their main diagnoses were classified into acute primary brain lesions (39%), primary brain pathologies without acute lesions (25%) and pathologies that affected the brain secondarily (36%). In-hospital mortality associated with persistent CUE amounted to 25%. 33% of patients with persistent CUE presented with more than one coma-explaining pathology. In 173 of the 1027 patients, CUE had already resolved on admission. However, these patients showed a spectrum of main diagnoses similar to persistent CUE and a significant in-hospital mortality of 5%. Conclusion The data from our cohort show that the spectrum of conditions underlying CUE is broad and may include a surprisingly high number of coincidences of multiple coma-explaining pathologies. This finding has not been reported so far. Thus, significant pathologies may be masked by initial findings and only appear at the end of the diagnostic work-up. Furthermore, even transient CUE showed a significant mortality, thus rendering GCS cutoffs for selection of high- and low-risk patients questionable. Taken together, our data advocate for a standardized diagnostic work-up that should be triggered by the emergency symptom CUE and not by any suspected diagnosis. This standardized routine should always be completed - even when initial coma-explaining diagnoses may seem evident.

scholarly journals Transthyretin Amyloidosis with Gastrointestinal Manifestation: a Case Report

2019 ◽  
Vol 28 (3) ◽  
pp. 359-361 ◽  
Author(s):  
Radislav Nakov ◽  
Stayko Sarafov ◽  
Ventsislav Nakov ◽  
Mariana Gospodinova ◽  
Tihomir Todorov ◽  
...  
Keyword(s):  
Diagnostic Challenge ◽  
Transthyretin Amyloidosis ◽  
Gi Symptoms ◽  
Peripheral Polyneuropathy ◽  
Life Threatening ◽  
Gastrointestinal Manifestation ◽  
Diagnostic Work ◽  
Biochemical Imaging ◽  
Work Up ◽  
Diarrhea Syndrome

Transthyretin amyloidosis (ATTR) is a rare, progressive, life-threatening, hereditary disorder caused by mutations in the transthyretin gene. Due to the phenotypic heterogeneity, ATTR is difficult to recognize and it is often diagnosed very late. In ATTR gastrointestinal (GI) disorders play an important role in the patients’ morbidity and mortality. In some cases, GI symptoms are present even before the onset of the peripheral polyneuropathy. However, the complaints are various and it is really difficult to differentiate them from other GI disorders. We present a 61-year old male referred for diarrhea, unintentional weight loss and early satiety. He had hypotension after longstanding hypertension, numbness and tingling in the feet. We considered a broad differential diagnosis spectrum of chronic diarrhea syndrome and performed numerous laboratory, biochemical, imaging, endoscopic, histological and genetic tests. Transthyretin amyloidosis with a Glu89Gln mutation was diagnosed. Transthyretin amyloidosis is frequently misdiagnosed, representing a diagnostic challenge in GI practice. The presence of certain clinical combinations could help gastroenterologists to include ATTR in their diagnostic work-up.

scholarly journals Ganglioneurofibroma Arising Within the Extralobar Pulmonary Sequestration

2020 ◽  
Author(s):  
Yuanyuan Liu ◽  
Wenbin Wu ◽  
Longbo Gong ◽  
Miao Zhang
Keyword(s):  
Mediastinal Lymph Node ◽  
Three Dimensional ◽  
Pulmonary Sequestration ◽  
Whole Body ◽  
Case Presentation ◽  
Lymph Node Sampling ◽  
Diagnostic Work ◽  
Work Up ◽  
Aberrant Vessels

Abstract Background: Neurogenic tumor arising within the pulmonary sequestration (PS) is rare.Case Presentation: A 42-year-old asymptomatic female was referred to our hospital for work-up of extralobar PS. The independent feeding artery from the thoracic aorta was confirmed by three-dimensional computed tomography angiography (3D-CTA). Extrapulmonary lesions were excluded by whole-body radiographical examinations. Uniportal thoracoscopic resection of the sequestrated lung and mediastinal lymph node sampling was performed successfully. Finally, ganglioneurofibroma within the PS was confirmed by pathological staining. The patient was discharged from the hospital on the 3rd postoperative day without tumor recurrence a year after surgery.Conclusion: Preoperative 3D-CTA is useful to verify the aberrant vessels of PS; whereas an elaborate diagnostic work-up after a timely resection is necessary for possible subsequent management and follow-up plan.

scholarly journals Flight of the COVID-19 patient: experience with aWuhan evacuee- a case report

2020 ◽  
Author(s):  
Sandeep Segar ◽  
Daniel Bouland ◽  
Francesca Torriani ◽  
Kevin Kwak ◽  
Deepak Asudani ◽  
...  
Keyword(s):  
Clinical Course ◽  
Antiviral Drug ◽  
World Health ◽  
Chest Imaging ◽  
Case Presentation ◽  
Global Pandemic ◽  
Night Sweats ◽  
Diagnostic Work ◽  
Health Organization ◽  
Work Up

Abstract Background:Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a global pandemic by World Health Organization in March 2020. Case Presentation:We report a case of a 51-year-old Chinese woman who was evacuated from Wuhan, China and diagnosed with COVID-19 infection at a Southern California quarantine facility. Clinical course was notable for high fevers, night sweats, productive cough, transient leukopenia, lymphopenia, thrombocytopenia, and transaminitis. Evolving hypoxia and infiltrates on chest imaging warranted the trial of an investigational antiviral drug - remdesivir. The patient recovered and was discharged after two weeks of hospitalization. Conclusion:This case highlights the patient’s clinical course including diagnostic work-up, medical management, and challenges in defining non-infectivity in a relatively unknown disease.

The Significance of Serum Anti-Borrelia Antibodies in the Diagnostic Work-Up of Uveitis

1997 ◽  
Vol 7 (3) ◽  
pp. 251-255 ◽  
Author(s):  
H. Mikkilä ◽  
I. Seppälä ◽  
M. Leirisalo-Repo ◽  
A. Karma
Keyword(s):  
Lyme Borreliosis ◽  
Antibody Test ◽  
Unknown Etiology ◽  
Positive Polymerase Chain Reaction ◽  
History Of ◽  
Polymerase Chain ◽  
Systemic Symptoms ◽  
Diagnostic Work ◽  
Work Up ◽  
Reaction Result

Purpose. To assess the utility of testing uveitis patients for anti-Borrelia antibodies in an area endemic for Lyme borreliosis. Methods. We examined 161 uveitis patients for serum antibodies to Borrelia burgdorferi by Lyme ELISA. Antibodies were determined in patients with uveitis of unknown etiology and non-selectively from patients with an established diagnosis. Results. Concentrations of antibodies to B. burgdorferi were elevated in 26 uveitis patients (16.1%), with elevated IgG in 11 of them (6.8%). In four of these patients Lyme borreliosis was a highly suggestive cause of uveitis because of a history of tick bites, systemic symptoms, response to antibiotic therapy, and/or a positive polymerase chain reaction result. Other causes of uveitis were ruled out. All these patients had vitritis. Conclusions. Non-selective testing of uveitis patients for Lyme antibodies is not reasonable even in endemic areas. We recommend using the Borrelia antibody test only in cases of uveitis of unknown cause, especially in patients with vitritis or other symptoms of Lyme borreliosis.

scholarly journals Cardiac Transthyretin Amyloidosis: Hidden in Plain Sight

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Constantine N. Logothetis ◽  
Joel Fernandez ◽  
Damian A. Laber
Keyword(s):  
Heart Failure ◽  
Cardiac Amyloidosis ◽  
Clinical Symptoms ◽  
Medical Condition ◽  
Medical Community ◽  
Unknown Etiology ◽  
Transthyretin Amyloidosis ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Amyloidosis is an underappreciated medical condition with symptoms camouflaging as common medical comorbidities leading to its underdiagnosis due to its systemic involvement. Despite common misconceptions, amyloidosis and its systemic comorbidities are more prevalent and treatable than previously acknowledged by the medical community. There are two major forms of amyloidosis: amyloid light-chain and transthyretin amyloidosis. Each of these have a distinct pathophysiology, diagnostic work-up, treatment, and prognosis. The patient described in this study was diagnosed with transthyretin cardiac amyloidosis months after presenting with heart failure of unknown etiology. Usually, clinicians presume that heart failure results from common comorbidities such as hypertension, diabetes, and hyperlipidemia. Here, the correct etiology was transthyretin cardiac amyloidosis. The patient had five admissions for heart failure symptoms prior to a physician identifying the etiology as cardiac transthyretin amyloidosis. After initiating the transthyretin stabilizer tafamidis, the patient did not experience another heart failure exacerbation. This vignette provides an example of the clinical presentation, diagnostic work-up, and treatment of a patient with cardiac transthyretin amyloidosis. The review of the literature focuses on the epidemiology, and clinical symptoms that should prompt an evaluation for cardiac amyloidosis as well as the diagnostic and therapeutic options are available. Transthyretin cardiac amyloidosis is a rare and underdiagnosed disease, while heart failure is a highly prevalent condition. This clinical vignette seeks to provide education and awareness to an overlooked medical disorder.

scholarly journals Alemtuzumab-associated diffuse alveolar damage – a case report

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Antonios Bayas ◽  
Martina Menacher ◽  
Martin Schwaiblmair ◽  
Bruno Märkl ◽  
Markus Naumann
Keyword(s):  
Lung Biopsy ◽  
Respiratory Symptoms ◽  
Diffuse Alveolar Damage ◽  
Productive Cough ◽  
Exertional Dyspnea ◽  
Case Presentation ◽  
Rare Side Effect ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Abstract Background Identifying causes of alemtuzumab induced respiratory symptoms in Multiple Sclerosis (MS) patients is crucial. Case presentation We report a case of diffuse alveolar damage (DAD) in a patient with MS after the first course of alemtuzumab treatment. A 42-year-old female developed progressive non-productive cough and exertional dyspnea 2 months after alemtuzumab treatment. DAD was diagnosed histopathologically by lung biopsy. The patient recovered completely, alemtuzumab was not continued. Conclusions Our case highlights another pathomechanism for non-infective lung-disorders in alemtuzumab treated MS patients. DAD is a potential, albeit rare side effect of alemtuzumab, broadening the spectrum of non-infective lung disorders that should be considered in the diagnostic work-up.

scholarly journals Case Report: Adenocarcinoma Of The Appendix Presenting As A Cervical Polyp.

2021 ◽  
Author(s):  
Emilie De Smedt ◽  
Bram Pouseele ◽  
Koen Vindevoghel ◽  
Nathalie Storme
Keyword(s):  
Case Reports ◽  
Residual Tumor ◽  
Right Hemicolectomy ◽  
Regional Lymph Nodes ◽  
Case Presentation ◽  
Vaginal Mass ◽  
History Of ◽  
Diagnostic Work ◽  
Work Up ◽  
Cervical Polyp

Abstract Background: The differential diagnosis of a vaginal mass after hysterectomy is broad. Malignancies of the genital tract or metastasis from another primary tumor should be excluded. Appendiceal carcinoma is a rare cause, case reports are limited.Case presentation: A 77-year-old woman with a history of vaginal hysterectomy presented with a 12-month history of vaginal pressure. The vaginal mass, penetrating trough the cervix, is resected (vaginal approach). A Microscopic examination of the removed tissue revealed an adenocarcinoma of the appendix. Right hemicolectomy, resection of the vaginal vault and resection of the regional lymph nodes showed no residual tumor.Conclusions: Full diagnostic work-up of a vaginal mass should be performed to avoid unexpected malignancy. Transvaginal resection was in this case feasible and safe.

scholarly journals Progressive Tumefactive Demyelination as the Only Result of Extensive Diagnostic Work-Up: A Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Pavel Štourač ◽  
Jan Kolčava ◽  
Miloš Keřkovský ◽  
Tereza Kopřivová ◽  
Leoš Křen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Case Report ◽  
Rare Variants ◽  
Young Female ◽  
Diagnostic Process ◽  
Diagnostic Challenge ◽  
Demyelinating Lesions ◽  
Diagnostic Work ◽  
Work Up ◽  
Brain And Spinal Cord

Tumefactive demyelinating lesions belong to the rare variants of multiple sclerosis, posing a diagnostic challenge since it is difficult to distinguish them from a neoplasm or other brain lesions and they require a careful differential diagnosis. This contribution presents the case report of a young female with progressive tumefactive demyelinating brain and spinal cord lesions. An extensive diagnostic process including two brain biopsies and an autopsy did not reveal any explanatory diagnosis other than multiple sclerosis. The patient was treated by various disease-modifying treatments without significant effect and died from ascendent infection via ventriculoperitoneal shunt resulting in Staphylococcus aureus meningitis.

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